ICD 10 CM IMPLEMENTATION DATE OCT 1, 2015

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Presented by:

Teri Romano, RN, MBA, CPC, CMDP

ICD‐10‐CM

IMPLEMENTATION DATE

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ICD‐9‐CM vs. ICD‐10‐CM • 3‐5 characters in length • 3‐7 characters in length • 1st character may be alpha, but is usually numeric; 2nd‐5th characters are numeric • Character 1 is alpha, character 2 is always numeric, characters 3‐7 can be either alpha or numeric • Approximately 14,000 codes • Approximately 69,000 codes • Limited space for adding new codes • Flexibility for adding new codes • Lacks detail • Very specific 3 Example: S12 Fracture of cervical vertebra and other parts of neck Note: A fracture not indicated as displaced or nondisplaced should be coded to displaced A fracture not indicated as open or closed should be coded to closed Includes: Fracture of cervical neural arch Fracture of cervical spine Fracture of cervical spinous process Fracture of cervical transverse process Fracture of cervical vertebral arch Fracture of neck

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Excludes Notes

The ICD‐10‐CM has two types of excludes notes

(recall that ICD‐9‐CM had only one type of excludes notes).



Excludes1



_Excludes2

5

Excludes1

This is a “pure” excludes. It means 'NOT CODED HERE!' and the

code excluded should never be used at the same time as the

code above the Excludes1 note.

M48.5‐

Collapsed vertebra, not elsewhere classified

Excludes 1

Current injury‐see injury of spine

pathological fracture of vertebra

due to neoplasm (M84.58)

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Excludes2

Means NOT INCLUDED HERE. An Excludes2 note indicates that the

condition is not part of the condition represented by the code, but a

patient could possibly have both conditions at the same time. In this

case, it could be acceptable to use both the code and the excluded

code together; such as:

M51‐

Thoracic, thoracolumbar and lumbosacral intervertebral

disc disorders

Excludes2

Cervical and cervicothoracic

disc disorder (M50.‐)

7 

“Other” or “Other Specified” ( Not Elsewhere Classified—NEC)



Use when information in the medical record provide detail

for which a specific code does not exist.



Specific disease is documented but there is no diagnosis code.



“Unspecified” ( Not Otherwise Specified‐ NOS)



Use when the information in the medical record is insufficient

to assign a more specific code.

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C H A P T E R 1 3 :

D I S E A S E S O F T H E M U S C U L O S K E L E TA L S Y S T E M

A N D C O N N E C T I V E T I S S U E

( M 0 0 ‐ M 9 9 )

M00‐M99

M

Chapter Organization

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This chapter BLOCK is broken down into the following categories: M00‐M02 Infectious arthropathies M05‐M14 Inflammatory polyarthropathies M15‐M19 Osteoarthritis M20‐M25 Other joint disorders M26‐M27 Dentofacial anomalies and other jaw disorders M30‐M36 Systemic connective tissue disorders M40‐M43 Deforming dorsopathies (e.g., kyphosis, scoliosis, spondylolysis, spondylolisthesis) M45‐M49 Spondylopathies (e.g., osteomyelitis of vertebra, infection of intervertebral disc, discitis, spondylosis, spinal stenosis) M50‐M54 Other dorsopathies (e.g., disc disorders, spinal instabilities, radiculopathy, sciatica, lumbago, low back pain) M60‐M63 Disorders of muscles (e.g., myositis) M65‐M67 Disorders of synovium and tendon (e.g., trigger finger) M70‐M79 Other soft tissue disorders (e.g., spinal synovial cyst) M80‐M85 Disorders of bone density and structure (e.g., osteoporosis with current pathological fracture, pathological fracture in neoplastic disease) M86‐M90 Other osteopathies (e.g., osteomyelitis, osteonecrosis) M91‐M94 Chondropathies M95 Other disorders of the musculoskeletal system and connective tissue M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified (e.g., fracture following insertion of implant, puncture, laceration, hemorrhage) M99 Biomechanical lesions, not elsewhere classified 11

SPINE DISORDER WHERE YOU’LL FIND IT

Stenosis, disc, spondylolisthesis, spondylosis, degenerative scoliosis/kyphosis M40‐M99.9 Musculoskeletal Chapter Chapter 13 Spine fractures, spinal cord injury, traumatic disc, subluxation, etc S12‐ S34.9‐ Injuries, Poisonings and Other Consequences of External Causes Chapter 19

Spinal and vertebral tumors C and D Neoplasms Chapter 2

Spinal abscesses, cysts, chronic pain, dural tear G00‐G99.8 Nervous System Chapter 6 Complications of devices ( spine hardware, neurostimulator, etc) Post‐op wound infection, spine T81‐T88.9 Injuries, Poisonings and Other Consequences of External Causes Chapter 19

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SPINE DISORDER WHERE YOU’LL FIND IT Stenosis, disc, spondylolisthesis, spondylosis, degenerative scoliosis/kyphoses M40‐M99.9 Musculoskeletal Chapter Chapter 13 Spine fractures, spinal cord injury, traumatic disc, subluxation, etc S12‐ S34.9‐ Injuries, Poisonings and Other Consequences of External Causes Chapter 19 Spinal and vertebral tumors C and D Neoplasms Chapter 2

Spinal abscesses, cysts, chronic pain, dural tear G00‐G99.8 Nervous System Chapter 6 Complications of devices ( spine hardware, neurostimulator, etc) Post‐op wound infection, spine T81‐T88.9 Injuries, Poisonings and Other Consequences of External Causes Chapter 19 13

Major Differences for Non‐Traumatic Spine?



Site specific, (occipito‐atlanto‐axial, high cervical)



Combination codes (with myelopathy and radiculopathy)



Character X and the 7

Th

_{character for healing status}



Clinical concepts added (radiculopathy)



Codes expanded (increased sites and increased categories of

codes)



Complications expanded

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

M40: Kyphosis and lordosis



M40.‐ Postural



M40.1‐ Other secondary kyphosis



M40.2‐ Other and unspecified kyphosis



M40.3‐ Flatback syndrome



M40.4‐ Postural lordosis, acquired lordosis



M40.5‐ Lordosis, unspecified



Tip: Use M96.‐ for post‐procedural kyphosis, scoliosis, etc.

Additional character(s) required for specific spinal region for the M40‐M43 code block. 15 

M41: Scoliosis



M41.0‐ Infantile idiopathic scoliosis



M41.1‐ Juvenile and adolescent idiopathic scoliosis



M41.2‐ Other idiopathic scoliosis



M41.3‐ Thoracogenic scoliosis



M41.4‐ Neuromuscular scoliosis

(e.g., scoliosis secondary to cerebral palsy)



M41.5‐ Other secondary scoliosis



M41.8‐ Other forms of scoliosis



M41.9 Scoliosis, unspecified

Additional character(s) required for specific spinal region for the M40‐M43 code block.

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

M43.0‐ Spondylolysis



M43.1‐ Spondylolisthesis (excludes traumatic and congenital)



0 site unspecified



1 occipito‐atlanto‐axial (C1‐C2)



2 cervical



3 Cervicothoracic



4 thoracic



5 thoracolumbar



6 Lumbar



7 lumbosacral



8 sacral and sacrococcygeal



9 multiple sites

17 M47.82‐ Other Spondylosis with Radiculopathy 

M47.1‐ Spondylosis

5th_Character 0 Site unspecified 1 Occipito‐atlanto‐axial (Occiput – C2) 2 Cervical (C1 – C7) 3 Cervicothoracic (C7 – T1) 4 Thoracic (T1 – T12) 5 Thoracolumbar (T12 – L1) 6 Lumbar (L1 – L5) 7 Lumbosacral (L5 – S1) 8 Sacral and sacrococcygeal 6th_Character 1 Occipito‐atlanto‐axial (Occiput – C2) 2 Cervical (C1 – C7) 3 Cervicothoracic (C7 – T1) 4 Thoracic (T1 – T12) 5 Thoracolumbar (T12 – L1) 6 Lumbar (L1 – L5) 7 Lumbosacral (L5 – S1) 8 Sacral and sacrococcygeal 9 Site unspecified M47.1‐ Other spondylosis with Myelopathy

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M47.81‐ Spondylosis without myelopathy or radiculopathy 

M47.‐ Spondylosis

6th_Character 1 Occipito‐atlanto‐axial (Occiput – C2) 2 Cervical (C1 – C7) 3 Cervicothoracic (C7 – T1) 4 Thoracic (T1 – T12) 5 Thoracolumbar (T12 – L1) 6 Lumbar (L1 – L5) 7 Lumbosacral (L5 – S1) 8 Sacral and sacrococcygeal 9 Site unspecified 19



M47.89‐ Other spondylosis, by site



M47.9 Spondylosis, unspecified



M48.0‐ Spinal stenosis

5th_Character 0 Site unspecified 1 Occipito‐atlanto‐axial (Occiput – C2) 2 Cervical (C1 – C7) 3 Cervicothoracic (C7 – T1) 4 Thoracic (T1 – T12) 5 Thoracolumbar (T12 – L1) 6 Lumbar (L1 – L5) 7 Lumbosacral (L5 – S1) 8 Sacral and sacrococcygeal

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

M54.01‐ Radiculopathy

5th_Character 0 Site unspecified 1 Occipito‐atlanto‐axial (Occiput – C2) 2 Cervical (C1 – C7) 3 Cervicothoracic (C7 – T1) 4 Thoracic (T1 – T12) 5 Thoracolumbar (T12 – L1) 6 Lumbar (L1 – L5) 7 Lumbosacral (L5 – S1) 8 Sacral and sacrococcygeal 21 New in ICD‐10 

M46.2‐ Osteomyelitis of vertebra



M46.4‐ Discitis

5th_Character 0 Site unspecified 1 Occipito‐atlanto‐axial (Occiput – C2) 2 Cervical (C1 – C7) 3 Cervicothoracic (C7 – T1) 4 Thoracic (T1 – T12) 5 Thoracolumbar (T12 – L1) 6 Lumbar (L1 – L5) 7 Lumbosacral (L5 – S1) 8 Sacral and sacrococcygeal

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

M50.‐ Cervical: requires 5th character for all subcategories listed below

5th_Character 0 Unspecified region 1 High cervical region (C2‐C3, C3‐C4) 2 Mid‐cervical region (C4‐C5, C5‐C6, C6‐C7) 3 Cervicothoracic region (C7‐T1)  M50.0‐ With myelopathy  M50.1‐ With radiculopathy  M50.2‐ Other disc displacement  M50.3‐ Other disc degeneration  M50.8‐ Other disc disorders  M50.9 Unspecified Code to the most superior level! 23 

M51.‐ Thoracic, thoracolumbar and lumbosacral: requires 5th character for

all subcategories listed below

5th_Character 4 Thoracic (T1‐T12) 5 Thoracolumbar (T12‐L1) 6 Lumbar (L1‐L5) 7 Lumbosacral (L5‐S1)  M51.0‐ With myelopathy  M51.1‐ With radiculopathy  M51.2‐ Other disc displacement  M51.3‐ Other disc degeneration  M51.4‐ Schmorl’s nodes  M51.8‐ Other disc disorders  M51.9 Unspecified

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

M54.2 Cervicalgia



_{M54.3‐ Sciatica}



New!!

Unspecified side, right, left



M54.4‐ Lumbago with sciatica



New!!

Unspecified side, right, left



M54.5 Low back pain



M54.6 Pain in thoracic spine



M54.9 Dorsalgia, unspecified

.

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Code symptoms only

when a more definite

diagnosis is not known

.

M96 Intraoperative and postprocedural complications and

disorders of musculoskeletal system, not elsewhere classified.



Examples:



_{M96.0 Pseudarthrosis after fusion or arthrodesis}



_{M96.1 Postlaminectomy syndrome, not elsewhere classified}



M96.81‐ Intraoperative hemorrhage and hematoma



M96.83‐ Postprocedural hemorrhage and hematoma

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

“Code all documented conditions that coexist at the time of the

encounter/visit, and require or affect patient care treatment or

management.”



_{For example: Code the primary reason for the visit (lumbar stenosis)}

but code underlying conditions if they affect your

treatment/surgical plan. For example, are you sending the patient

to their cardiologist for a pre‐op evaluation for co‐existing cardiac

conditions? Code those conditions. Important for risk based

contracting and potential future payment models such as bundled

payments and ACOs.

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“X” placeholder is used to provide

room for future expansion

“X” placeholder is used to keep applicable

7 th

_{character in the 7}

th

_{position when the}

code is less than 6 characters long.

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

_{M53.2 Spinal instabilities}



M53.2X1 Spinal instabilities,

occipito‐atlanto‐axial region



M53.2X2 Spinal instabilities, cervical region



M53.2X3 Spinal instabilities, cervicothoracic region



M53.2X4 Spinal instabilities, thoracic region



Etc.

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“X” placeholder is used to provide

room for future expansion.

“X” placeholder is used to

keep the 7

th

_{character in the 7}

th

position when a code is less than

6 characters long.

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For Fractures 6 options The appropriate 7th_{character is to be added to each code from category S02} A ‐ initial encounter for closed fracture B ‐ initial encounter for open fracture D ‐ subsequent encounter for fracture with routine healing G ‐ subsequent encounter for fracture with delayed healing K ‐ subsequent encounter for fracture with nonunion S ‐ sequela For Non‐Fractures 3 options The appropriate 7th_{character is to be added to each code from category S14} A ‐ initial encounter D ‐ subsequent encounter S ‐ sequela 31

Initial Encounter (A, B) = In Active Treatment

Examples include:

surgical treatment,

emergency department

encounter and evaluation

and continuing treatment

by a new or the same

physician.

(2015 Guideline update!)

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Subsequent Encounter (D, G, K, P) = In Healing or Recovery Phase

Examples include: cast change or

removal, an x‐ray to check healing

status of fracture, removal of external or

internal fixation device, medication

adjustment, other aftercare and

follow up visits following treatment

of the injury or condition

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Sequela (S) = Late effect, residual effect

of a prior condition‐ not a complication

Examples include: scar formation resulting from a burn,

deviated septum due to nasal fracture, infertility due to

tubal occlusion from prior disease

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Diagnosis

(ICD‐10‐CM) Coding

Procedure (CPT) Coding

Term Encounter Visit

Type Initial: the patient is in the active phase or treatment for an injury or fracture New patient: the patient has not been seen by the physician or other qualified health care provider in the same specialty, same group in the past 3 years Subsequent: after the active treatment phase is over Established patient: the patient has been seen by a physician or other qualified health care provider in the same specialty, same group practice within the past 3 years

7th Character

35

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Chapter Highlights – Pathologic Fracture/

Osteoporosis Related

M80

M80.08‐ √ x 7

th

Osteoporosis

with current pathological fracture, vertebra(e)

M80.88‐ √ x 7

th

Other

osteoporosis with current pathological fracture, vertebra(e)

39 Image source: http://upload.wikimedia.org/wikipedia/commons/1/17/Blausen_0250_CompressionFracture_Vertebrae.png

Chapter Highlights –

Pathologic Fracture in Neoplastic Disease

M84

M84.58‐ √ x 7

th

Pathological fracture in neoplastic disease,

other specified site

(vertebrae)

Code also underlying neoplasm

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Coding of Pathologic Fractures

For pathological fractures

The appropriate 7th _character

A initial encounter for fracture

D subsequent encounter for fracture w/ routine healing

G subsequent encounter for fracture w/ delayed healing K subsequent encounter for fracture w/ nonunion P subsequent encounter for fracture w/ malunion S sequela 41 Image source: http://upload.wikimedia.org/wikipedia/commons/1/17/Blausen_0250_CompressionFracture_Vertebrae.png



Fatigue fractures (M48.40‐M48.48)

(A type of stress fracture due to abnormal stress

on normal bone)



Collapsed vertebra (M48.50‐

M48.58 Codes)

Each of these categories of codes will need an X placeholder for a valid code.

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For fatigue fractures and collapsed vertebra

4 options

The appropriate 7

th

_{character is to be added to each code}

A ‐ initial encounter for closed fracture

D ‐ subsequent encounter for fracture with routine healing

G ‐ subsequent encounter for fracture with delayed healing

S ‐ sequela

43 

_{All will require a 7}

th

_character:



T81.4 Infection following a procedure



T84.84 Pain due to orthopedic internal prosthetic device, implants

and grafts. (painful hardware)



_{T85.1‐ Mechanical complication of implanted electronic stimulator}

of nervous system ( codes for breakdown, displacement, other)



T84.2‐ Breakdown, displacement, other of internal fixation device of

vertebrae

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3 options

The appropriate 7

th

_{character is to be added to each code}

A ‐ initial encounter

D ‐ subsequent encounter

S ‐ sequela

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1. C3‐C7 spondylosis with myelopathy

M47.12 Spondylosis with

myelopathy

EXERCISES

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2. L4‐L5 spinal stenosis, herniated disc and

spondylolisthesis

EXERCISES

M48.06 Stenosis lumbar region

M51.26 Herniated lumbar disc

M43.16 Spondylolisthesis

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3. L4‐L5 spinal stenosis

M48.06 Stenosis lumbar region

EXERCISES

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4. L4‐S1 spinal stenosis

EXERCISES

M48.06 Stenosis lumbar region

M48.07 Stenosis lumbosacral region

Teaching point: 2 diagnoses may be

needed ‐ who knows?

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5. C5‐C6 herniated disc. Radiculopathy

EXERCISES

M50.12 Herniated disc with radiculopathy,

mid‐cervical region

Teaching point: ICD‐10‐CM includes specific

spinal regions of “high,” “mid” and junctional

for some codes.

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6. L5‐S1 herniated disc

M51.27 Other lumbosacral disc

displacement

EXERCISES

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7. L4 radiculopathy

M54.16 Radiculopathy, lumbar

Teaching point:

Code did not exist in ICD‐9‐CM.

EXERCISES

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8. Low back pain

M54.5 Lumbago

EXERCISES

53

M71.38 Other bursal cyst, other site

M48.06 Stenosis, lumbar

9. Synovial cyst at L4‐L5. Stenosis at L3‐L5

EXERCISES

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M84.58XA

Pathological fracture in other

disease, other site

M46.44

Discitis, unspecified,

thoracic region

10. Operative note shows the following – Postoperative

diagnosis: T4 pathologic fracture secondary to

osteodiscitis

EXERCISES

55

M84.58XA Pathologic fracture due to

neoplastic disease

C79.51

Vertebral mets

Teaching point: Code also underlying neoplasm.

11. T12 pathologic fracture due to metastatic lung

cancer at time of vertebral augmentation

procedure

EXERCISES

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12. L4‐L5 osteomyelitis

M46.26 Osteomyelitis of

vertebra, lumbar region

EXERCISES

57

13. Pseudoarthrosis L4‐L5

M96.0 Pseudoarthrosis after

fusion or arthrodesis

EXERCISES

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14. Lumbar instability, lumbar stenosis

1) M53.2X6 Spinal instabilities,

lumbar region

2) M48.06

Stenosis,

lumbar region

EXERCISES

59

M43.16

Spondylolisthesis, lumbar region

M51.36

Other intervertebral disc degeneration,

lumbar region

M48.06 Stenosis, lumbar region

15. Post‐op diagnosis; Spondylolisthesis, grade 1, L4‐L5,

degenerative disc disease lumbar spine, spinal

stenosis, neural foraminal stenosis, lumbago, sciatica

EXERCISES

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karenzupkoandassociates @KarenZupkoAssoc [email protected] 312.642.5616 www.karenzupko.com

Teri Romano

RN, MBA, CPC, CMDP